Rosa Hormeño Bermejo

BACKGROUND: To assess the quality of the prescribing of antibiotics to patients treated at a hospital emergency department (HED). METHODS: Retrospective study of the 8600 patients treated and released from a HED throughout the January-April 1996 period. Those patients for whom antibiotics were prescribed as stated on the release form were included. The parameters employed for assessing the prescribing quality were: illness subject to being treated with antibiotics, proper antibiotic, dosage, proper frequency and length of time over which the antibiotic is to be taken. Each one of these parameters was assigned a mark affording the possibility of quantifying quality on a 0-100 point scale. The assessment of the extent to which proper treatment was prescribed was made based on the recommendations described on four guides to the use of antibiotics. RESULTS: Antibiotics were prescribed to 609 (7.1%) of the patients, basically for treating urinary tract infections (17.7%), the prevention of wound infection (13.1%) and for the treatment of repeated attacks of chronic obstructive pulmonary disease (COPD) (10.3%). The antibiotic most often prescribed was cloxacillin (22.5%), followed by ciprofloxacin (13.4%) and clarithromycin (13.2%). Of all of the patients treated with antibiotics, 10.8% had no illness or any indication subject to being treated with these medications, and 32% of those patients who did indeed meet these requirements were prescribed an unsuitable antibiotic. Pneumonia was the illness for which the best quality of treatment was provided. The average mark for the prescriptions did not total 80 points in any of the guides. CONCLUSIONS: Antibiotics are medications frequently prescribed in HED's. Major errors are found to exist with regard to the indication, selection and length of the treatments initiated with these medications, as a result of which it is advisable that sustained educational measures be taken.

FUNDAMENTO: valorar la eficacia de roxitromicina en pacientes asmaticos con titulaciones de IgG frente a Chlamydia pneumoniae ≥ 1:16. METODOS: estudio doble ciego, randomizado y control con placebo en el que han participado 92 asmaticos de entre 183 enfermos con titulaciones de IgG frente a C. pneumoniae ≥ 1:16 (Microinmunofluorescencia Indirecta, MIF, MRL Diagnostic, EE.UU.). 41 asmaticos recibieron 300 mg de roxitromicina via oral al dia durante 21 dias y otros 51 asmaticos placebo durante igual periodo de tiempo. Seguimiento serologico (IgG, IgE) y clinico mediante entrevistas las semanas 0 (primer dia de tratamiento), 4a, 8a y 26a. RESULTADOS: el 61,2% de los asmaticos adultos del Area de Salud de Lucena-Cabra-Montilla presentan titulaciones de IgG frente a C. pneumoniae ≥ 1:16 . El 53,7% de los pacientes tratados con roxitromicina presentaron mejoria clinica y del flujo espiratorio maximo (FEM) (p<0,029) a la 8.a semana postratamiento. Asi mismo, un 54% de los tratados disminuyeron las titulaciones de IgG frente a C. pneumoniae en dos o mas niveles, frente al 14% del grupo placebo (p<0,012). No hay cambios significativos en las titulaciones de IgE. CONCLUSIONES: las titulaciones de IgG frente a C. pneumoniae ≥ 1:16 son frecuentes en asmaticos del Area de Salud de Lucena-Cabra-Montilla. En muchos de estos casos (54%) el tratamiento con roxitromicina aporta una notable mejoria clinica.